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Behandlung der Borderline-Persönlichkeitsstörung mit atypischen Antipsychotika

Treatment of borderline personality disorder with atypical antipsychotic drugs

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Zusammenfassung

Die medikamentöse Behandlung der Borderline-Persönlichkeitsstörung mit atypischen Antipsychotika war zuletzt Gegenstand mehrerer, meist kleiner Studien und Fallserien. Im Gegensatz zur verbreiteten klinischen Anwendung dieser Substanzklasse bei Borderline-Patientinnen und -Patienten ist die Datenlage nach wie vor spärlich. Die bislang publizierten Daten sprechen für einen potenziellen Nutzen der atypischen Antipsychotika bei psychotischer Symptomatik, bei Impulsivität und möglicherweise auch bei affektiven Symptomen. Die Verträglichkeit war bei meist niedrigen Dosierungen und kurzen Beobachtungszeiträumen akzeptabel. Die bisherige Datenlage unterstützt nicht die oft praktizierte Polypharmazie, allerdings gibt es erste Hinweise auf synergistische Effekte einer Kombinationsbehandlung aus atypischem Antipsychotikum und störungsspezifischer Psychotherapie. Künftige Studien sollten größere Patientenkollektive untersuchen und längere Beobachtungszeiten aufweisen. Die Fragen der erforderlichen Dosis und der optimalen Behandlungsdauer ist gegenwärtig noch offen.

Summary

Pharmacotherapy of Borderline personality disorder with atypical antipsychotics has recently been the subject of several mostly small studies and case reports. In contrast to the frequent clinical use of this substance class in borderline patients the amount of data on that subject is still sparse. The clinical data gathered thus far suggest a potential use of atypical antipsychotics in the areas of psychotic symptoms, impulsivity and possibly affective symptoms. The drugs were sufficiently well tolerated; however, the observation period in most studies was short and the dosage low. The current set of clinical data does not support the frequently applied polypharmacy. However, recent data suggest that a therapeutic approach combining atypical antipsychotics and psychotherapy may reveal synergistic effects. Future trials should study larger sample sizes over a longer period of time. Open questions are the required dose and the optimal treatment duration.

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Authors and Affiliations

  1. Klinik und Poliklinik für Psychiatrie und Psychotherapie, Heinrich-Heine-Universität , Bergische Landstraße 2, 40629 , Düsseldorf, Deutschland

    A. Mobascher, J. Mobascher & J. Malevani

  2. Klinik für Psychosomatik und Psychotherapeutische Medizin, Zentralinstitut für Seelische Gesundheit, Mannheim, Deutschland

    C. Schmahl

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  1. A. Mobascher
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  2. J. Mobascher
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  3. C. Schmahl
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  4. J. Malevani
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Correspondence to A. Mobascher.

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Mobascher, A., Mobascher, J., Schmahl, C. et al. Behandlung der Borderline-Persönlichkeitsstörung mit atypischen Antipsychotika. Nervenarzt 78, 1003–1013 (2007). https://doi.org/10.1007/s00115-006-2243-3

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  • DOI: https://doi.org/10.1007/s00115-006-2243-3

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